title: Maternal race and neonatal outcomes after elective repeat cesarean delivery.
abstract: OBJECTIVE
  To determine the effect of race in the risks of prematurity-related complications (PRC) after elective repeat cesarean delivery (ERCD).
  
  
  METHODS
  The NCHS-CDC Database for the U.S. (2004-2008) was used. ERCD cases were included. Exclusion criteria were multiple gestation, trial of labor, fetal anomalies, history of diabetes and/or hypertension. PRC analyzed were: Apgar score, assisted ventilation, intensive care admission, surfactant use, antibiotic use, seizures. Regression analysis was performed to calculate the odds ratio (OR) of these variables. Deliveries at 36-40 weeks were studied with 40 weeks as reference.
  
  
  RESULTS
  Totally, 785,340 ERCDs were performed between 36 and 40 weeks. For the overall population, there was not difference in adverse outcomes between 39 and 40 weeks. The rates of PRC were significantly higher in newborns at 38 compared to 39 weeks, with similar findings in sub-analysis of whites. For African-Americans, the rate of PRC was not significantly different at 38 compared to 39 weeks.
  
  
  CONCLUSIONS
  We report increased rates of PRC after ERCD before 39 weeks, similar findings from smaller hospital-based studies. For African-American newborns, there was no further decrease in PRC after 38 weeks suggesting earlier maturation of these fetuses. The study does not propose changing the current 39 weeks threshold for ERCD.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center , Detroit, MI , USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vilchez
authors.forename: Anushka
authors.initials: A
authors.lastname: Chelliah
authors.forename: Pedro
authors.initials: P
authors.lastname: Argoti
authors.forename: Roohi
authors.initials: R
authors.lastname: Jeelani
authors.forename: Ray
authors.initials: R
authors.lastname: Bahado-Singh
mesh_terms: D001741:Black or African American; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000208:ethnology* / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States; D044465:White People